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Background Minor cranial sutural synostosis is currently regarded as a rare diagnosis. As clinical awareness grows, a greater number of cases are being documented. This study aims to describe the variants of unicoronal synostosis with regard to major and minor sutural involvement and secondary effects on cranial and orbital morphology. The information is aimed to improve clinical diagnosis and management. Methods A retrospective study was conducted collecting preoperative computed tomographic scans of patients diagnosed with unicoronal synostosis and listed for surgical interventions, identified from a craniofacial database. Within these patients, different synostotic variants were identified based on which suture was affected. Scans of normal pediatric skulls (trauma) were used for a control group. Computed tomographic scans were analyzed for sutural involvement, cranial base deflection, and ipsilateral and contralateral orbital height and width. One-way analysis of variance was used to detect differences between synostotic variants and controls. Results A total of 57 preoperative computed tomographic scans of patients with unicoronal synostosis were reviewed, in addition to 18 computed tomographic scans of normal skulls (control group). Four variants of unicoronal synostosis were identified: frontoparietal, frontosphenoidal, frontoparietal and frontosphenoidal, and frontosphenoidal and frontoparietal. The last two variants differ in their temporal involvement in the direction of sutural synostosis and ultimately cranial and orbital morphology. Three variants have been previously identified, but the fourth is presented for the first time. Conclusions An understanding of the variants of unicoronal synostosis and their temporal relationships is integral for accurate clinical diagnosis and surgical correction. Recommendations for treatment are based on discrete changes in orbital morphology.

Objective To investigate the stability of major versus minor Le Fort I maxillary advancements in unilateral cleft lip and palate (UCLP) patients. Design A retrospective longitudinal study was undertaken on 30 nonsyndromic UCLP patients treated with the same protocol at The Hospital for Sick Children, Toronto, Canada. Patients were grouped into major and minor movement groups based on planned surgical advancement. Standard lateral cephalometric radiographs were taken preoperatively (T1), immediately postoperatively (T2), and at least 1 year postoperatively (T3). Skeletal and dental variables were measured using cephalometric analysis. Stability was compared between groups using repeated-measures analysis of variance. Linear regression analysis was used to assess the relationship between advancement and relapse for the entire study population. Results A mean maxillary advancement of 9.8 mm and 4.9 mm was seen for the major (n = 10) and minor (n = 20) movement groups, respectively. The mean skeletal horizontal relapse was 1.8 mm (18%) for the major advancement group and 1.5 mm (31%) for the minor advancement group. There was no significant difference in skeletal horizontal relapse between the groups ( P > .05). The correlation coefficient ( r) between linear horizontal advancement and relapse was calculated to be .31 ( P > .05). Dental horizontal relapse was not significant for either the major or minor groups, and no significant difference was found between the groups ( P > .05) Conclusion Skeletal and dental relapse was found to be unrelated to the amount of maxillary linear advancement using conventional Le Fort I osteotomies in UCLP.

Background Different methods have been described for the reconstruction of cranial defects and orbital defects. The complex contouring between the orbital roof and frontal bone creates significant design challenges for prefabricated cranio-orbital reconstructions. In describing the first reported patient of combined skull and orbital roof reconstruction with a single-piece titanium plate cranioplasty, the authors present a new method of combined complex cranio-orbital reconstruction. Methods A 63-year-old lady presented with a large, right-sided frontal en-plaque meningioma involving the right orbit and sphenoid wing. Complete resection would require reconstruction of both the skull and the orbital roof. Surgical preplanning involved marking resection margins on a three-dimensional (3D) printed acrylonitrile-butadiene-styrene model. This margin was used to virtually resect the tumor and generate a repaired surface. A titanium plate was then fabricated using hydrostatic pressing into a 3D-printed mold and the orbital roof portion (a reentrant surface) was hand-finished. Lateral canthus and temporalis muscle suspension holes were prefabricated into the cranioplasty plate. Results The patient underwent hemicraniectomy and tumor resection guided by a custom-made 3D-printed cutting guide. The surgical defect was reconstructed with the prefabricated titanium plate achieving a good functional and cosmetic result. Conclusion Single-piece titanium plate cranioplasty is an effective novel reconstruction method for complex cranio-orbital defects.

Objective: The aim of this qualitative study was to analyze the content of posts on Twitter in order to gain an in-depth understanding of patients’ thoughts and experiences surrounding orthognathic surgical treatment. Materials and Methods: Using the Twitter search function, with the keywords “jaw surgery,” the 1,000 most recent posts on Twitter with relevance to a combined orthodontic and orthognathic surgical treatment were extracted. After applying relevant inclusion and exclusion criteria, the selected posts were analyzed using thematic analysis by 2 independent investigators. Distinct themes and subthemes were developed. Results: A total of 689 posts were analyzed; the 3 main themes identified in relation to orthognathic surgery were preoperative engagement, postoperative difficulties, and posttreatment satisfaction. Twelve subthemes were also identified, expressing issues such as anticipation or apprehension of the surgical procedure, postoperative pain and edema, dietary restrictions and weight loss, paresthesia, depression, and satisfaction with improvements in appearance and self-confidence. The 6 terms most frequently used in tweets were “recovery,” “braces,” “swollen,” “eat,” “liquid diet,” and “pain.” Conclusions: The findings from the present study can increase the awareness of clinicians involved in the combined orthodontic and orthognathic surgical treatment of patients with dentofacial deformities, allowing them to better educate and counsel their patients throughout the entire treatment process.

Purpose To investigate the stability of single-piece versus segmental (2-piece) maxillary advancement in patients with unilateral cleft lip and palate (UCLP) treated using conventional Le Fort I orthognathic surgery. Patients and Methods A retrospective study was undertaken in 30 patients with nonsyndromic UCLP treated with the same surgical and orthodontic protocol from 2002 through 2011. Standard lateral cephalometric radiographs were taken preoperatively, immediately postoperatively, and at least 1 year postoperatively. Patients were divided into single-piece and segmental Le Fort I groups based on planned surgical movement. Postoperative movements were compared between groups using repeated measures analysis of variance. Results The mean skeletal horizontal advancement was 7.3 and 7.5 mm in the single-piece and segmental groups, respectively. The skeletal horizontal relapse was 1.3 mm (18%) for the single-piece group and 1.9 mm (25%) for the segmental group. The skeletal surgical extrusion was 2.7 mm for the 2 groups. The skeletal vertical relapse was 0.6 mm (22%) and 1.5 mm (56%) for the single-piece and segmental groups, respectively. The mean dental horizontal postoperative movement was an advancement of 0.4 mm for the single-piece group and a relapse of 0.2 mm (3%) for the segmental group. The mean dental vertical relapse was 0.1 mm (4%) for the single-piece group and 0.3 mm (11%) for the segmental group. There was no statistically significant difference in relapse between the single-piece and segmental groups for all movements ( P > .05). Conclusion Skeletal and dental relapse was similar between single-piece and segmental maxillary advancements using conventional Le Fort I orthognathic surgery in patients with UCLP.

Objective To determine the frequency of need for orthognathic surgery among nonsyndromic patients with isolated cleft palate repaired during infancy at The Hospital for Sick Children in Toronto, Canada. Design Retrospective cohort study. Patients Patients with nonsyndromic isolated cleft palate born between 1970 and 1997 with available records including a lateral cephalometric radiograph taken at 15 years of age. Methods Patients who had undergone or were being prepared for orthognathic surgery were automatically counted as requiring surgery. For the remaining patients, lateral cephalometric radiographs were traced and analyzed. Arbitrarily set cephalometric criteria were used to identify the “objective” need for orthognathic surgery. Results Of the 189 patients identified with nonsyndromic isolated cleft palate and for whom records were available, 25 (13.2%) were deemed to require orthognathic surgery. Of the surgical cohort, 92% required surgical correction for a Class III malocclusion. Similar percentages of males and females required orthognathic surgery. An apparently greater proportion of patients of Asian background (18.5%) than of white background (10.6%) required surgery, but this difference was not significant ( P = .205). Conclusions The current results suggest that approximately one in eight patients at our institution with nonsyndromic isolated cleft palate requires orthognathic surgery. There is a tendency for this to be higher in patients of Asian descent and lower in patients of white descent. Variability in extent, severity, and phenotype of the cleft, which may be attributed largely to genetics, may play an important role in dictating the need for orthognathic surgery.